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by Lisa Wangsness
The Boston Globe
November 11, 2009

WASHINGTON - Massachusetts officials are closely monitoring an abortion funding ban in the sweeping health care legislation before Congress to make sure that it does not restrict women’s access to abortion coverage in the state.

Abortion is a covered service for low-income Massachusetts women enrolled in subsidized insurance plans available since 2006 through the state’s landmark health care law.

But the bill that squeaked through the US House late Saturday would prohibit private insurance plans from covering abortion if they accept federal subsidies. It also bans abortion coverage in the new government insurance option.

State officials say there are too many uncertainties about how a new federal system would interact with the state’s to know yet exactly how, or whether, the abortion provision in the House bill would affect coverage in Massachusetts. But theoretically, if the state used new federal subsidies to replace or augment the funds in its existing system, that new money could come with strings attached limiting abortion coverage.

“We obviously feel that having full access to all reproductive services is very important to a woman’s overall health,’’ said Juan Martinez, communications director for the state Executive Office of Health and Human Services. As with other aspects of the health reform law, he said yesterday, “we continue to work with the Massachusetts delegation to make sure what we’ve established in Massachusetts is protected and preserved.’’

Under a provision known as the Hyde Amendment, which Congress has reapproved each year since the late 1970s, federal money in the Health and Human Services budget cannot be used to pay for abortions, except in cases or rape, incest, or the life of the mother being in danger.

But Massachusetts and a number of other states cover abortion under Medicaid, the insurance program for low-income people jointly financed by the state and federal government, by using state money.

Massachusetts and most of the other states whose Medicaid programs cover abortion do so under a court order. A 1981 Massachusetts Supreme Judicial Court decision said that if the state covers some reproductive health services under Medicaid, it has to cover all of them.

The Connector Authority, which is in charge of implementing the state’s health reform law, included abortion coverage in Commonwealth Care, the subsidized insurance program for low-income people, to follow the same constitutional principle, officials said. Since a combination of state and federal money pays for the subsidies, the state says it calculates the approximate cost of abortion services and pays for that portion.

Abortion opponents say the provision added to the House bill to ensure passage just guarantees what is already the law, which is that no federal money will be used to cover abortions. Without the provision, they fear some federal taxpayer money will find its way into the subsidies.

“Our argument is as long as you want to pay for abortions with private dollars, then there is not a problem,’’ said Charmaine Yoest, president of Americans United for Life.

But abortion rights advocates say the amendment actually goes far beyond existing law, creating what would be the most extensive new restrictions on abortion in years. Because 85 percent of the people who buy insurance through the new “exchange’’ would receive subsidies, they say, most private insurance plans in the exchange would not offer any plans covering abortion.

“What the House voted on takes us far beyond that status quo and raises a lot of questions about whether women at any income level would be able to obtain timely access to abortion care and be able to exercise the right to choose as this moves forward,’’ said Andrea Miller, executive director of NARAL Pro Choice Massachusetts.

Abortion rights advocates in Massachusetts are trying to analyze the potential effect the amendment could have on the state’s health plan, said Dianne Luby, president and CEO of the Planned Parenthood League of Massachusetts.

“If what was passed over the weekend went into effect - I think the question is out there that we don’t know the answer to just yet - women could definitely be worse off than they are right now,’’ she said.

The issue flared up as a significant point of controversy in the debate. The anti-abortion provision passed with the support of most Republicans and about 60 Democrats, some of whom threatened to vote against the entire health care bill unless House Speaker Nancy Pelosi allowed a vote on their amendment.

But now, more than 40 House liberals who voted in favor of the bill on Saturday say they won’t support a final version containing that language.

In the Senate, where similar differences have emerged, majority leader Harry Reid is trying to devise a compromise as he races to get a bill to the floor in the coming weeks.

“I expect the bill that will be brought to the floor will ensure that no federal funds are used for abortions . . .’’ Reid said yesterday. “I think we can work that out.’’

It is also a treacherous issue for President Obama, who campaigned as a strong supporter of abortion rights but also as a candidate who could bridge differences over such difficult issues. In an interview with ABC News on Monday, Obama suggested he was concerned that the House amendment went too far and would change the status quo.

“I want to make sure that the provision that emerges meets that test - that we’re not in some way sneaking in funding for abortions, but, on the other hand, that we’re not restricting women’s insurance choices,’’ he said.


Planned Parenthood League of Massachusetts


November 11, 2009